Offer summary

Qualifications:

5+ years of experience handling indemnity claims within California., Strong analytical, negotiation, and communication skills., Proficiency in Microsoft Office and claims management systems., California Self-Insurance Administrator (SIP) certification highly preferred..

Key responsabilities:

Investigate, evaluate, and adjust California workers’ compensation claims according to best practices and regulations.

Maintain excellent diary management for proactive claim handling and timely resolution.

Authorize and process timely indemnity payments and claim-related expenses.

Communicate effectively with claimants, clients, medical providers, and other stakeholders throughout the claims process.

Job description

Overview:

Workers' Compensation Claim Specialist
Remote | Reporting to Irvine, CA Branch
Monday - Friday, 8:00 AM - 4:30 PM PST
Salary Range: $85,000 - $99,000

Salary Disclaimer: The posted salary reflects the anticipated base pay for this role. Actual pay will depend on qualifications, experience, and internal equity. Additional compensation may include bonuses, benefits, or other forms of pay. Discuss compensation and benefits questions with our hiring team.

About CCMSI:
CCMSI is a leading Third-Party Administrator (TPA) specializing in workers’ compensation and liability claims management. We are committed to delivering exceptional service and tailored solutions to our clients across various industries.

Position Overview:
CCMSI is seeking an experienced Workers' Compensation Claim Specialist to join our team. This fully remote position reports to our Irvine, CA branch and manages a multiple-account desk within various industries, handling claims exclusively in the California jurisdiction. The ideal candidate will have 3+ years of experience managing indemnity claims in California, with a strong ability to review claims from onset to closure, maintain excellent diary management, process timely indemnity payments, and provide outstanding customer service. A California Self-Insurance Administrator (SIP) certification is highly preferred.

Responsibilities:

Investigate, evaluate, and adjust California workers’ compensation claims in accordance with CCMSI best practices and state regulations.
Maintain excellent diary management to ensure proactive claim handling and timely resolution.
Establish reserves and provide reserve recommendations within designated authority levels.
Authorize and process timely indemnity payments and claim-related expenses per company standards.
Ensure compliance with California workers’ compensation laws, corporate claim handling standards, and client-specific guidelines.
Communicate effectively with claimants, clients, medical providers, attorneys, and other stakeholders throughout the claims process.
Compute disability rates in accordance with California state law.
Coordinate and oversee services provided by outside vendors, including legal counsel, surveillance, and case management when necessary.
Assess and monitor subrogation claims for resolution.
Provide notices of qualifying claims to excess/reinsurance carriers.
Maintain compliance with all CCMSI reporting requirements and best practices.
Potential travel 1-2 times per year for meetings or training.

Qualifications:

Preferred Qualifications & Skills:

5+ years of experience handling indemnity claims within California.
Strong analytical, negotiation, and communication skills.
Ability to work independently and manage multiple claims efficiently.
High attention to detail, organization, and initiative.
Proficiency in Microsoft Office and claims management systems.
California SIP certification highly preferred.
Adjuster’s license may be required based on jurisdiction.

Performance Measurement:

Meeting or exceeding CCMSI internal best practices for claim handling.
Timely processing of indemnity payments and required notices.
Strong diary management and proactive claim resolution.
Providing exceptional customer service to clients and stakeholders.

Why Join CCMSI?

At CCMSI, we offer a dynamic and supportive work environment with opportunities for career growth and professional development. As a remote employee, you will have the flexibility to manage your workload while being part of a collaborative team dedicated to excellence in claims management.

CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefits package, including Medical, Dental, Vision, Life Insurance, ESOP, and 401K. Background checks are conducted per applicable laws.

Ready to Apply?

If you are a detail-oriented and experienced Workers' Compensation Claim Specialist, we encourage you to apply and join our team at CCMSI!

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